Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery

Adachi, Tomohiko; Eguchi, Susumu; Beppu, Teruhiko; Ueno, S.; Shiraishi, Masayuki; Okuda, K; Yamashita, Yo‐ichi; Kondo, Kazuhiro; Nanashima, Atsushi; Ohta, Masayuki; Takami, Yuko; Noritomi, Tomoaki; Kono, Kenji; Fujioka, Hikaru

doi:10.1245/s10434-014-4239-8

Cited by 66 publications

(49 citation statements)

References 22 publications

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“…Data from our group and others have emphasized the importance of assessing the lymph node basin to stage patients accurately. 9,[25][26][27] The finding that lymph node metastasis were strongly associated with risk of extrahepatic recurrence serves to emphasize the importance of assessing the regional nodal basins. While lymph node metastasis may indeed portend a higher risk of extrahepatic recurrence and indicate the need for adjuvant therapy, postoperative therapy unfortunately remains largely ineffective.…”

Section: Discussionmentioning

confidence: 99%

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Spolverato

Kim

Alexandrescu

et al. 2015

JCO

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349 Background: Many patients develop recurrence following resection of intrahepatic cholangiocarcinoma(ICC). Management and outcomes of patients with recurrent ICC following previous curative-intent surgery are not well documented. We sought to characterize the treatment of patients with recurrent ICC and define therapy-specific outcomes. Methods: Between 1990-2013, 542 patients who underwent surgery for ICC were identified from an international database. Data on clinicopathological characteristics, operative details, recurrence and recurrence-related management were recorded and analyzed. Results: At initial surgery, treatment was resection only(96.1%) or resection+RFA(3.9%). Overall 5-year survival was 25.9%; 376(69.4%) patients recurred with a median disease-free survival of 11.0 months. Vascular invasion(hazard ratio [HR]=1.43), nodal metastasis(HR=1.40) and poor differentiation(HR=1.30) were predictive of recurrence(all P<0.05). First recurrence site was intrahepatic only (62.0%), extrahepatic only (14.1%), or intra- and extrahepatic(23.9%). Overall 259(68.9%) patients received treatment for recurrent ICC, while 117(31.1%) received best supportive care(BSC). Among patients who received treatment for recurrent disease, therapy consisted of systemic chemotherapy only(49.4%), repeat liver-directed therapy (25.9%), or systemic chemotherapy+liver-directed therapy(24.7%). Repeat liver-directed therapy consisted of repeat hepatic resection±ablation(30.5%), ablation alone (21.4%), and intra-arterial therapy(IAT)(48.1%). Among patients who recurred, median survival from the time of the recurrence was 11.0 months(BSC-7.7 months, systemic chemotherapy only-10.0 months, liver-directed therapy-18.0 months). The median survival of patients undergoing resection of recurrent ICC was 26.7 months versus 7.6 months for patients who had IAT(P<0.001). Conclusions: Recurrence following resection of ICC is common, occurring in up to two-thirds of patients. When recurrence occurs, prognosis is poor. In well-selected patients with liver only recurrence, resection+chemotherapy may offer a modest survival benefit.

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Section: Discussionmentioning

confidence: 99%

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Spolverato

Kim

Alexandrescu

et al. 2015

JCO

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“…One study showed a positive predictive value for metastatic disease of 67% in round lymph nodes exceeding 18 mm which are rare [17]. Another study used positron emission tomography-computed tomography (PET-CT) and concluded that preoperative evaluation remains difficult [18] while a recent metaanalysis demonstrated PET-CT imaging to be accurate in the evaluation of primary tumors, lymph node and distant metastasis [19]. The most recent article found lymph node enlargement with a small axis diameter exceeding 1 cm in preoperative imaging as the strongest predictor for histopathological lymph node metastases [20].…”

Section: Introductionmentioning

confidence: 99%

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

et al. 2020

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Background: Intrahepatic cholangiocarcinoma (ICC) is often diagnosed at an advanced stage resulting in a low resectability rate. Even after potentially curative resection the risk for tumor recurrence is high. Although the extent and value of lymphadenectomy is part of ongoing discussion, the role of preoperative imaging for assessment of suspicious lymph nodes (suspLN) has only been studied modestly. Aim of this study is to demonstrate the influence of suspicious lymph nodes in preoperative imaging on resectability, recurrence, and long-term outcome.Methods: All patients who underwent exploration for ICC between January 2008 and June 2018 were included. Preoperative imaging (CT or MRI) was analysed with focus on suspLN at the hepatoduodenal ligament, lesser curvature, interaortocaval, and superior to the diaphragm; suspLN were classified according to the universally accepted RECIST 1.1 criteria; histopathology served as gold standard.Results: Out of 187 patients resection was performed in 137 (73.3%), in 50 patients the procedure was terminated after exploration. Overall, suspLN were found preoperatively in 73/187 patients (39%). Comparing patients who underwent resection and exploration only, suspLN were significantly more common in the exploration group (p = 0.011). Regarding lymph node stations, significant differences could be shown regarding resectability: All tumors with suspLN superior to the diaphragm were irresectable. Preoperative imaging assessment showed a strong correlation with final histopathology, especially of suspLN of the hepatoduodenal ligament and the lesser curvature. Sensitivity of suspLN was 71.1%, specificity 90.8%. Appearance of tumor recurrence was not affected by suspLN (p = 0.289). Using a short-axis cut-off of <> 1 cm, suspLN had significant influence on recurrence-free survival (RFS, p = 0.009) with consecutive 1-, 3-, and 5-year RFS of 41, 21, and 15% versus 29, 0, and 0%, respectively. Similarly, 1-, 3-and 5-year overall survival (OS) was 75, 30, and 18% versus 59, 18, and 6%, respectively (p = 0.040).

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“…The ability to preoperatively predict lymph node status would be very useful in deciding therapeutic strategies for ICC patients. However, the majority of reports have concluded that predicting lymph node metastasis from preoperative imaging is difficult for biliary cancers …”

Section: Introductionmentioning

confidence: 99%

“…However, the majority of reports have concluded that predicting lymph node metastasis from preoperative imaging is difficult for biliary cancers. [16][17][18][19] Carbohydrate antigen (CA)19-9 was originally isolated from a culture medium of a human colorectal cancer cell line by Koprowski et al 20,21 in 1979 and is widely known as a useful biomarker in the diagnosis of several adenocarcinomas, including cholangiocarcinoma. [22][23][24][25] In addition, some reports have identified preoperative serum CA19-9 (s-CA19-9) level as an independent prognostic factor in ICC patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of serum carbohydrate antigen 19‐9 level on prognosis and prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma

Yamada

Nakanishi

Okamura

et al. 2018

J of Gastro and Hepatol

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Prognostic Impact of Preoperative Lymph Node Enlargement in Intrahepatic Cholangiocarcinoma: A Multi-Institutional Study by the Kyushu Study Group of Liver Surgery

Abstract: Preoperative evaluation of LNM proved to be difficult, and survival time in ICC patients with lymph node enlargement was prolonged as a result of hepatectomy. Thus, ICC patients with preoperative lymph node enlargement should not be prematurely deemed non-curative cases.

Cited by 66 publications

References 22 publications

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative intent surgical resection.

Relevance of suspicious lymph nodes in preoperative imaging for resectability, recurrence and survival of intrahepatic cholangiocarcinoma

Impact of serum carbohydrate antigen 19‐9 level on prognosis and prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma

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